Medizinische Universität Graz - Research portal
Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Zweiker, R.
Eligibility and subsequent burden of cardiovascular disease of four strategies for blood pressure-lowering treatment: a retrospective cohort study
J HYPERTON. 2019; 23(2): 56-+.
Web of Science
- Leading authors Med Uni Graz
- Zweiker Robert
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- Abstract:
- Background: Worldwide treatment recommendations for lowering blood pressure continue to be guided predominantly by blood pressure thresholds, despite strong evidence that the benefits of blood pressure reduction are observed in patients across the blood pressure spectrum. In this study, we aimed to investigate the implications of alternative strategies for offering blood pressure treatment, using the UK as an illustrative example. Methods: We did a retrospective cohort study in primary care patients aged 30-79 years without cardiovascular disease, using data from the UK's Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality. We assessed and compared four different strategies to determine eligibility for treatment: using 2011 UK National Institute for Health and Care Excellence (NICE) guideline, or proposed 2019 NICE guideline, or blood pressure alone (threshold > 140/90 mmHg), or predicted 10-year cardiovascular risk alone (QRISK2 score >= 10%). Patients were followed up until the earliest occurrence of a cardiovascular disease diagnosis, death, or end of follow-up period (March 31, 2016). For each strategy, we estimated the proportion of patients eligible for treatment and number of cardiovascular events that could be prevented with treatment. We then estimated eligibility and number of events that would occur during 10 years in the UK general population. Findings: Between Jan 1, 2011, and March 31, 2016, 1,222.670 patients in the cohort were followed up for a median of 4.3 years (IQR 2.5-5.2). 271.963 (22.2%) patients were eligible for treatment under the 2011 NICE guideline, 327.429 (26.8%) under the proposed 2019 NICE guideline, 481.859 (39.4%) on the basis of a blood pressure threshold of 140/90 mmHg or higher, and 357.840 (29.3%) on the basis of a QRISK2 threshold of 10% or higher. During follow-up, 32.183 patients were diagnosed with cardiovascular disease (overall rate 7.1 per 1000 person-years, 95% CI 7.0-7.2). Cardiovascular event rates in patients eligible for each strategy were 15.2 per 1000 person-years (95% CI 15.0-15.5) under the 2011 NICE guideline, 14.9 (14.7-15.1) under the proposed 2019 NICE guideline, 11.4 (11.3-11.6) with blood pressure threshold alone, and 16.9 (16.7-17.1) with QRISK2 threshold alone. Scaled to the UK population, we estimated that 233.152 events would be avoided under the 2011 NICE guideline (28 patients needed to treat for 10 years to avoid one event), 270.233 under the 2019 NICE guideline (29 patients), 301.523 using a blood pressure threshold (38 patients), and 322.921 using QRISK2 threshold (27 patients). Interpretation: A cardiovascular risk-based strategy (QRISK2 >= 10%) could prevent over a third more cardiovascular disease events than the 2011 NICE guideline and a fifth more than the 2019 NICE guideline, with similar efficiency regarding number treated per event avoided.